Breathlessness

Feeling short of breath during activities that never used to trouble you should never be dismissed as "getting older" or "being unfit". Breathlessness can be one of the most important warning signs of heart disease — and one that is frequently overlooked until a condition has advanced. A prompt specialist assessment gives you either clear reassurance or early treatment, when outcomes are best.

Breathlessness can arise from the heart, the lungs, or general health factors. Common causes include:

Heart-related (cardiac) causes:

• Heart valve disease — particularly aortic stenosis, a narrowing of the heart's main outflow valve. Breathlessness on exertion is often its first and most important symptom
• Heart failure — when the heart cannot pump efficiently, fluid can build up in the lungs, causing breathlessness on exertion, on lying flat, or waking you at night
• Coronary artery disease — narrowed heart arteries can cause breathlessness instead of, or alongside, chest pain; this is sometimes called an "angina equivalent"
• Heart rhythm problems — such as atrial fibrillation, which can reduce the heart's efficiency
• Cardiomyopathy — diseases of the heart muscle itself

Non-cardiac causes:

• Lung conditions such as asthma, COPD or infection
• Anaemia (low blood count)
• Being overweight or deconditioned
• Anxiety

Many of these conditions can coexist — and cardiac causes are easily missed when breathlessness is attributed to age, weight or fitness. A structured specialist assessment identifies or excludes heart disease definitively.

You should arrange a prompt cardiac assessment if you notice:

• Breathlessness during activities you previously managed comfortably — climbing stairs, walking uphill, carrying shopping
• A gradual reduction in how far or fast you can walk
• Breathlessness when lying flat, or waking at night gasping for breath
• Breathlessness with swollen ankles, palpitations, chest tightness or dizziness
• Breathlessness that is simply getting worse over weeks or months

This matters especially if you are over 65 or have risk factors such as high blood pressure, high cholesterol, diabetes or a heart murmur. In aortic stenosis, for example, the onset of breathlessness marks the point at which the condition requires assessment and, often, treatment — outcomes are far better when it is caught early.

Your first appointment lasts up to 45 minutes and includes:

1. A detailed discussion of your symptoms — when the breathlessness occurs, how it has changed over time, and what you can no longer do that you once could
2. A review of your risk factors and medical history, including any known murmurs or previous heart problems
3. A physical examination — listening to the heart and lungs and checking for signs of fluid retention
4. A clear plan — I will explain the likely causes and arrange the right investigations quickly

Breathlessness assessment is guided by your symptoms and examination findings. Investigations I can arrange rapidly include:

• Echocardiogram — the key test for breathlessness: an ultrasound scan showing the heart's pumping function and all four valves
• ECG — to detect rhythm problems and signs of heart strain
• Blood tests — including NT-proBNP, a marker of heart failure, plus checks for anaemia and thyroid problems
• CT coronary angiogram — a non-invasive scan of the heart's arteries
• Exercise or stress testing — to assess how your heart performs under exertion and objectively measure your limitation
• Ambulatory heart monitoring — if a rhythm problem is suspected
• Invasive coronary angiography — where coronary artery disease needs definitive assessment, performed by me personally

Most patients complete their initial assessment and key investigations within one to two weeks.

Treatment depends entirely on the cause:

• Heart valve disease — mild disease is monitored; significant disease may need valve intervention. I perform TAVI for aortic stenosis, a minimally invasive keyhole valve replacement carried out through a small puncture in the groin, with most patients home within a day or two
• Coronary artery disease — treated with medication and, where needed, coronary angioplasty and stenting (PCI)
• Heart failure — modern medications are highly effective and can transform both symptoms and long-term outlook when started early
• Heart rhythm problems — managed with medication or referral for specialist rhythm procedures
• If your heart is healthy, you receive clear reassurance, and I will point you towards the right assessment for non-cardiac causes

Because I am an interventional and structural cardiologist, your diagnosis and any procedure you need can be managed as a single, seamless pathway.

• Consultant Interventional and Structural Cardiologist with subspecialty expertise in aortic stenosis, TAVI and coronary artery disease — the major cardiac causes of breathlessness
• PhD from King's College London and advanced fellowship training in Milan, with over 100 peer-reviewed publications
• Rapid access — same-week appointments at Welbeck Street (Marylebone), Cromwell Hospital (Kensington) and The Wellington Hospital (St John's Wood)
• End-to-end care — from first consultation through echocardiography to valve intervention or stenting, under one consultant
• Consultations in English and Turkish
• Recognised by all major private medical insurers; self-paying patients welcome

Breathlessness that limits your life deserves expert answers — quickly. Contact my practice team to arrange a consultation.

Contact Ms Amelia Garner (PA) on 020 3198 9826 or drozandemir.sec@outlook.com to arrange a consultation.